Acumen Fiscal Agent Online Enrollment Frequently Asked Questions (FAQs): Employee Enrollment

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1 Acumen Fiscal Agent Online Enrollment Frequently Asked Questions (FAQs): Employee Enrollment Below you will find a brief summary and FAQs about each of the forms required in order to establish your selected Self Directed Habilitation Training Specialist as your employee. Form I-9 The Federal law requires every employer to fill out a Form I-9 for each employee. The purpose of this form is to document that each new employee (both citizen and noncitizen) hired after November 6, 1986, is authorized to work in the United States. Q: What do I need to fill out? A: Employee Citizenship statuss (Section1) Employee Signature and Date (Section2) List A or List B and List C (Section 2) The employee s hire date in the small field under the Certification section (Section 2) Print your name as the employer, sign, and date at the bottom of the page. Q: Do I need to fill out the Preparer and/or Translator Certification? A: If you did not require a translator in order to read this document, then this section does not apply. Leave this section blank. Q: Do I need to fill out Section 3? A: Section 3 is not required at this time because you are enrolling your employee for the first time. You must review your employee s identification documents in order to fill out this form. Read the instructions to know which documents are acceptable forms of identification. You must then make copies of the IDs and send them to Acumen Fiscal Agent with your employee paperwork 1

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3 Driver s License State of Arizona # Exp: 12/31/2013 SSC or Social Security Card SSA or Social Security Admin /01/2011 Jane Smith Jane Smith Domestic Employer Consumer Name 132 Mesa Drive, Phoenix, AZ /27/11 3

4 Form W-4 Form W-4 is used to identify the correct amount of federal income tax withholding to deduct from the employee s paychecks. The form allows the employee to calculate how many allowances they expect to be eligible for that year. The more allowances claimed, the less income tax is withheld from the paychecks. Employees may want to review their withholding every year especially after finishing their tax return. Q: What do I need to fill out? A: The employee needs to complete fields 1-7 and sign and date in order for Acumen Fiscal Agent to accept the form. The signature and date are located at the bottom of the form. If they do not complete all fields, their income tax withholding will be defaulted to Single status with 0 allowances which correspondss to the highest amount of income tax withheld from each paycheck. An employee may not indicate any allowances in Line 5 and also claim EXEMPT on Line 7. Q: How does my employee find out how many allowances they should claim? A: Use the Personal Allowances Worksheet in the middle of form to help calculate this number. The instructions on the top of the form are very useful as well. Q: How can my employee change their withholding after it has been submitted during their enrollment with Acumen Fiscal Agent? A: Simply fill out the form and submit it. The changes will go into effect immediately. 4

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6 Employee Rate Sheet: The Employee Rate Sheet form is required in order for Acumen Fiscal Agent to know how much you want to pay your employee. The pay rate must match exactly to the authorization Acumen Fiscal Agent has on file issued by Oklahoma Department of Human Services. If the rate indicated on your form does not match the authorization exactly, Acumen Fiscal Agent must reject this rate sheet and request a revised one. Q: Can I pay my employee any amount that I choose? A: You must select a pay rate from the Show Me the Money chart and get it approved by your Case Manager. This will ensure that the pay rate indicated on the authorization matches the rate you have chosen. Q: What do I need to fill out? A: Employer needs to complete the entire form. Please be sure to sign and date at the bottom of the page. Please be sure to indicate the Effective Date which is the date you would expect the employee to receive their first paycheck at this rate. (Enter the month you want your employee s rate to start and circle the 1 st or 2 nd half of the month.) 6

7 Lisa Thomas Steven Smith John Smith 7

8 Pay Selection Agreement: The Pay Selection Agreement tells Acumen Fiscal Agent how the employee prefers to receive their payments. Q: What do I need to fill out? A: Employee needs to sign and date this Form. Lisa Thomas 852 Main Street Phoenix AZ

9 Authorization for Direct Deposit: The Authorization for Direct Deposit form is only required if your employee chooses Direct Deposit as their preferred method of payment. Q: What do I need to fill out? A: Employee must provide their banking information in the boxes. They must also print their name, sign, date, and provide their social security number and phone number. Q: My employee says they only have one bank account, why are there 2 boxes provided? A: Two boxes are provided so that the employee may request that their paychecks are deposited into two different accounts. The employee must indicate what percentage of the total paycheck they want to be depositedd into each account. This is called partial direct deposit. Q: Can anyone access my personal money? A: No, we do not have access to your personal money or account. If your employeee is doing partial direct deposit, make sure that the total of each percentage indicated for each bank account equals 100% 9

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11 Employee Information Form: The purpose of the Employee Information Form is to obtain employee s general information and identify if certain tax exemptions are applicable based on the employer/employee relationship. Q: What do I need to fill out? A: The employee needs to sign and date this form. The signature and date are located at the bottom of the page. 11

12 Lisa Thomas Self-Directed Habilitation Training Specialist 852 Main Street Provider Agreement Form: Phoenix, AZ The Self- Maricopa Directed Services Habilitation Training Specialist (SD-HTS) Provider Agreement is between the Oklahoma Departmentt of Human John Smith Services, Developmental Disabilities Steven Services Smith Division, and employee. 12

13 Q: What do I need to fill out? A: The Employer needs to fill out the effective date and termination date on Page 2 The Employer and Employee need to sign and date on the bottom of page 4 in the left corner. The Case Manager needs to sign and date at the bottom of page 4 in the left corner. 13

14 Page 2 All SD-HTS shall be provided pursuant to the Service Recipient s Individual Plan, Plan of Care and budget. AGREEMENT PERIOD: This Agreement is effective on and terminates on, unless terminated in accordance with the terms and conditions of this Agreement. Payment does not include room and board or maintenance, upkeep and improvements to the Service Recipient s or family s residence. Self-Directed Habilitation Training Specialists will be limited to a maximum of 40 hours per week regardless of number of Service Recipients served. * More than one SD-HTS may provide care to a Service Recipient on the same day. However, payment cannot be made for services provided by two or more SD-HTS to the same Service Recipient during the same hours of a day. Page 4 As SD-HTS, my signature acknowledges that I have read, understand, and agree to the terms of this Agreement Including all of the rights and responsibilities outlined in the Agreement. In consideration of these promises and representations, and IN WITNESS WHEREOF, the parties have executed this Agreement as of the effective date set forth above. Self-Directed Habilitation Training Specialist (SD-HTS) Lisa Thomas Type or print name Signature Date: Service Recipient/Representative Steven Smith Type or print name Signature Date: Representative of OKDHS/DDSD Type or print name Signature Date: 14

15 Certificate of Competency Form: The Certificatee of Competency form must be submitted when a friend, neighbor, family member, or other person will be providing the services and has already completed the required trainings and certifications. Q: What do I need to fill out? A: The Employer needs to fill in the Relationship to Service Recipient field and sign and date in the middle of this form. 15

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17 Lisa Thomas Steven Smith John Smith 17

18 OK OSBI Record Check Form: A background check is required in order for your employee to startt working. The Oklahoma State Bureau of Investigation Form is required in order for us to run this background check. Q: What do I need to fill out? A: On the Requestors Information Box, the employee s signature is needed. In the Subject Information Box, the employee s need to fill in if they had an Alias/Maiden Name(S). Q: Do I need to complete the Search Results box? A: No, these boxes will be completed once the results of the background check are returned. Q: Do I need to fill out the Acceptable Forms of Payment box? A: No, please leave this blank. Acumen Fiscal Agent will complete this when we submit the form. 18

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